Review of "Quitting the Nairobi Trio"

Knipfels memoir of his six-month stay in a psychiatric ward is a good read. Readers of his previous memoir, Slackjaw, will already know that he is an ornery type who takes pride in his difference from other people. At the time of his hospitalization, he was a graduate student in philosophy, and the book he carried around with him in the ward was Ecrits by the French psychoanalytic post-structuralist theorist Jacques Lacan. He even gives he readers a crash course in basic Lacanian theory in order to explain some of his thought processes, although he concludes that Lacan didnt know anything about how people with severe mental illnesses actually think.

Unlike Slackjaw, Quitting focuses on a narrow period of time: a suicide attempt and the subsequent hospitalization. It helps a little to have read the previous memoir, because then you know a little about some of the people Knipfel writes about; but for the most part, the two books are entirely separate. I dont recall his even mentioning a prolonged hospitalization in Slackjaw. Knipfel writes mostly about his fellow patients and his frustration about his treatment. He waslocked up for six months, and apparently the only reason he was released is that state law of Minnesota says that patients cannot be hospitalized against their will for more than six months unless they are dangerous or unable to look after themselves. The mental health care he received during his stay was minimal: ten minutes with a psychiatrist once a week. No medication, no group therapy, no visits with a social worker. In short, it seems that his stay was a waste of time and money.

It is never made clear who paid for this stay: since he was a graduate student we can be sure that Knipfel didnt, and I very much doubt that any health insurance company or maintenance organization would have been willing to cover the costs. While his parents care for him deeply, theres no sign that they gave their consent for their son to be hospitalized or that they funded his stay. The logical conclusion is that taxpayers footed the bill. While it is no great shock that such money is being wasted, it is surprising that such money is available for psychiatric care. The far more common story these days is that people desperately needing care are unable to get it. Although it is not entirely clear when his stay was, it looks like it was in the early 1990s, and funds for public mental health services have been low at least since the early Reagan years in the US.

The notes on the cover are entirely misleading. They say that Knipfel enjoyed his time in the "bughouse" and they say that it was his self-analysis and an insight from watching one of his favorite comics Ernie Kovacs that enabled Knipfel to get out. But Knipfel is as ambivalent about life on the inside as he is about life in the "real world" and he never really makes any friends on the ward. He makes clear that his mental state hardly changed at all during his stay; what he learns is that most people on the ward are not really any more crazy than other people he knows on the outside. The only difference is that the people on the ward had been noticed and locked up by the authorities.

Of course, people who have been on locked psychiatric wards may not be the most reliable sources of information about their own mental states. Readers dont have any way of judging the accuracy of Knipfels story for themselves, apart from its inherent plausibility or lack of it. Knipfel does say he has attempted suicide several times in the past, and he gives a detailed description of the attempt that led to his hospitalization. Part of the reason for the length of his stay might be that, as a result of the overdose he attempted, he experienced several days of hallucinations. He awoke from his psychotic break reciting rhyming couplets from the philosopher Nietzsche. Knipfel devotes six chapters to his hallucinations, although how accurate are his recollections is certainly up for question, especially since he was not even allowed paper to write on during his stay. They dont add much to the story.

Another reason for the length of his stay might be that on his first night in the psychiatric ward, his roommate, maybe upset to have to share a room, broke a mirror and cut himself up. Although Knipfel slept through most of the episode, it left the doctors and nurses very suspicious of him and they often questioned him about what happened to the shards of the mirror. They were worried that the pieces where being passed around among the patients, and could enable more suicide attempts by others.

Knipfels talent for writing makes his book a quick read, and he has a good eye for observation. But its not clear what there is to learn from his experience. It is curious that Knipfel was locked up for six months, but he doesnt seem to bear any grudges about it, even if his psychiatrist comes across as incompetent. At one point one of the nurses sneaked out at night to show him special rooms with straightjackets, straps on beds, and a machine for electroshock treatment, but it is no great surprise to find that these are used in Minneapolis General Medical Center, because they are standard for most psychiatric hospital wards. We are not given any reason to think that they were overused; Knipfel only sawone person strapped down, and in that case, the patient seemed intent on doing some violence, so the use of force was appropriate. Mostly the psychiatric drugs given to patients keeps them quiet, and Knipfel seems to find their use more shocking than any other part of standard treatment.

All in all then Quitting gives a compelling account of one mans experience. His experience is probably different from that of most mental patients, but he has an interesting persepctive.